[Chemotherapy-induced nausea and vomiting: from experimentation to experience]

Chemotherapy-induced nausea and vomiting, two of the most distressing side-effects of cancer chemotherapy, have been the subject of a number of fundamental and clinical investigations. These have led to the development of a novel class of antiemetic agents, the 5-HT3 receptor antagonists. The pathophysiology of the emetic reflex and the clinical management of emesis are very complicated. Two experimental preclinical animal models are available (ferret and dog) and are particularly used to assess monochemotherapy as a single dose. Results are fairly good for acute nausea and vomiting. However, no optional animal model is available for the assessment of delayed and anticipated emesis. The clinical settings are so complex and variable that they preclude the development of an adequate model in all cases. It is also impossible to carry out clinical studies to assess each issue. Management of nausea and vomiting depends on the analysis by the physician of individual and drug-related parameters and on his own expertise. Scores can be assigned to each parameter and a decision tree can be elaborated to help the decision and improve the management of patients. The first goal is to obtain an optimal control of emesis from the very first cycle of chemotherapy in order to ensure good control during subsequent cycles.